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Research ArticleIMAGING

Sources of Apical Defects on a High-Sensitivity Cardiac Camera: Experiences from a Practice Performance Assessment

Leo L. Tsai, Kevin J. Donohoe, Margaret K. Stokes, Thomas H. Hauser, Gerald M. Kolodny, Thomas C. Hill and J. Anthony Parker
Journal of Nuclear Medicine Technology September 2013, 41 (3) 197-202; DOI: https://doi.org/10.2967/jnmt.113.124198
Leo L. Tsai
1Department of Radiology, Beth Israel Deaconess Medical Center, Boston, Massachusetts; and
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Kevin J. Donohoe
1Department of Radiology, Beth Israel Deaconess Medical Center, Boston, Massachusetts; and
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Margaret K. Stokes
1Department of Radiology, Beth Israel Deaconess Medical Center, Boston, Massachusetts; and
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Thomas H. Hauser
2Cardiovascular Institute, Beth Israel Deaconess Medical Center, Boston, Massachusetts
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Gerald M. Kolodny
1Department of Radiology, Beth Israel Deaconess Medical Center, Boston, Massachusetts; and
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Thomas C. Hill
1Department of Radiology, Beth Israel Deaconess Medical Center, Boston, Massachusetts; and
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J. Anthony Parker
1Department of Radiology, Beth Israel Deaconess Medical Center, Boston, Massachusetts; and
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  • FIGURE 1.
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    FIGURE 1.

    Example cardiac perfusion scans from 2 patients. (A) Scan from an 86-y-old woman with reversible apical defect. Coronary angiogram revealed a 90% stenosis of left anterior descending artery. (B) Scan from a 50-y-old woman demonstrating fixed apical defect. Gated images demonstrated normal wall motion and thickening. Subsequent clinical workup was negative for CAD.

  • FIGURE 2.
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    FIGURE 2.

    Mosaic plot demonstrating presence of apical artifacts against amount of soft tissues overlying chest wall. Both axes are scaled by fraction of individuals, compared with total number within each group. Amount of tissue ranges from minimal or none (0), to very little (A), to a very large amount (E).

  • FIGURE 3.
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    FIGURE 3.

    Cardiac perfusion examination demonstrating artifactual apical defects, with standard reconstruction (A) and one with decreased iterative reconstruction (B). Both stress and rest images were acquired, with stress images located along upper rows. These images are attenuation-corrected. Arrows highlight area of apical defect improvement after adjusted reconstruction.

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    TABLE 1

    Summary of Patient Population and Results of Cardiac Perfusion Studies

    Total no. of…nAngiography-proven CAD before examinationElevated risk of acute coronary syndrome (>10% at 10 y)
    Patients5344858
     Men3093114
     Women2251744
    Apical defects962535
     True apical defects30140
     Artifactual apical defects661135
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    TABLE 2

    Summary of Results Comparing Presence of Apical Artifacts with Clinical Correlates

    Clinical correlates against presence of apical artifactsAssociation and Pearson χ2 valueP value, Fisher exact test
    Female sexPositive, 32.7P < 0.001
    Degree of overlying soft-tissuesPositive, 19.5P < 0.002
    Presence of breast cleavagePositive, 7.15P < 0.008
    Angiography-confirmed CADNegative, 6.88P < 0.02
    Elevated cardiac risk (>10% at 10 y)Negative, 14.6P < 0.0001
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    TABLE 3

    Interobserver Comparison for Detection of Apical Artifacts

    Observer 1
    Observer 2NormalArtifact
    Normal110
    Artifact1425
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    TABLE 4

    Comparison of Reconstruction Methods by Observer 2

    ImprovedUnchangedWorse
    Normal7180
    Artifact1790
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Journal of Nuclear Medicine Technology: 41 (3)
Journal of Nuclear Medicine Technology
Vol. 41, Issue 3
September 1, 2013
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Sources of Apical Defects on a High-Sensitivity Cardiac Camera: Experiences from a Practice Performance Assessment
Leo L. Tsai, Kevin J. Donohoe, Margaret K. Stokes, Thomas H. Hauser, Gerald M. Kolodny, Thomas C. Hill, J. Anthony Parker
Journal of Nuclear Medicine Technology Sep 2013, 41 (3) 197-202; DOI: 10.2967/jnmt.113.124198
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Keywords

  • cardiology (basic/technical)
  • instrumentation
  • quality assurance
  • iterative reconstruction
  • myocardial perfusion
  • practice performance assessment
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Sources of Apical Defects on a High-Sensitivity Cardiac Camera: Experiences from a Practice Performance Assessment
Leo L. Tsai, Kevin J. Donohoe, Margaret K. Stokes, Thomas H. Hauser, Gerald M. Kolodny, Thomas C. Hill, J. Anthony Parker
Journal of Nuclear Medicine Technology Sep 2013, 41 (3) 197-202; DOI: 10.2967/jnmt.113.124198

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